American College of Physicians issues new policy to curb painkiller abuse

By Ryan Jaslow

December 9, 2013 / 6:21 PM
/ CBS News

A leading medical group is urging U.S. doctors to take more
steps to prevent prescription drug abuse in patients -- a dangerous, growing
trend that’s been seen with opioid pain pills.

The new policy statement released by the American College of
Physicians (ACP), one of the largest professional societies for U.S. doctors, calls
for medical professionals to put more effort towards reducing
risk for substance abuse.

The policy offers 10 new recommendations including supporting of the formation of a national prescription drug monitoring program to
identify patients who are at risk for significant drug abuse, more education
and prevention efforts for doctors and patients, and considering
written agreements for doctors and patients when treating pain.

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The ACP also calls for doctors to prescribe all controlled substances electronically and not on paper to ensure safety and decrease
likelihood controlled substances are diverted.

“The goal of this paper is to provide physicians and
policymakers with a set of recommendations to address the significant human and
financial costs related to prescription drug abuse,” wrote the American College
of Physicians in its policy statement, published Dec. 9 online in its journal, Annals of Internal Medicine.

The new policy statement urges doctors to look first to
non-opioid treatments when a patient comes in with pain. They do not however
urge a set maximum dosage or treatment time limit, since all cases can vary.

The ACP also supports the call for a national Prescription
Drug Monitoring Program so that prescribers
and dispensers can check in their own and neighboring states before writing and
filling prescriptions for substances with high abuse potential. Some states have their own programs currently.

Pain management contracts, another recommendation, have become more common at
hospitals, according to ACP. These documents often contain terms about what the treatment
will entail, prohibited behaviors, points when the treatments are terminated,
patient responsibilities, goals and emergency and legal considerations.

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Such efforts are needed because tolerance and withdrawal make opioid addictions possible.
For example, a person may be prescribed a prescription painkillers like
oxycodone or hydrocodone with acetaminophen after an accident or medical
procedure. Eventually that amount may not have the same desired effect due to
how the drugs are processed in the brain, making the person more tolerant. If they obtain more drugs, they might
take more than prescribed to reach that desired effect.

Then once they’re off the drugs, they might feel sick with withdrawal symptoms like anxiety, irritability, runny nose, abdominal pains and
nausea. If available, they take the drugs -- or similar opioids, like heroin --
just to combat these symptoms, fueling the addictive cycle.

Dr. Molly Cooke, president of the ACP and a professor at the
University of California, San Francisco school of medicine, told CBS News that
patients should realize that drugs are not intended to eliminate 100 percent of
pain.

"If that's what the patient's mindset is he's likely
going to come back and say, I wasn't getting enough relief and I doubled the
prescription," she said.

Dr. Stephen Loyd told CBS News that even as a physician, he fell
victim to this cycle. Loyd was in the last year of his residency when he
started taking prescription painkillers that were leftover from a dental
procedure.

“The anxiety started to build up and really became the only
way I could deal," he said.

Loyd has since recovered and now shares his story with others. He got treatment, resumed his medical
career and has been clean for 10 years.

“The
reason I share my story is to let folks know you can get better,” he said.